Lieberman M E, Levitt M A
Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, PA 19107.
Am J Emerg Med. 1989 Jan;7(1):28-31. doi: 10.1016/0735-6757(89)90079-x.
Traumatic rupture of the spleen has been well described in the medical literature and is found in approximately 30% of patients undergoing surgery for blunt abdominal injury. Atraumatic splenic rupture is described much less often. A case of atraumatic rupture of an enlarged spleen is described. The etiology of spontaneous rupture of the spleen in this case could not be determined. The patient was seen and discharged twice from the emergency department; the diagnosis was made at emergency laparotomy three days after subsequent admission. This case should remind the emergency physician that nontraumatic splenic rupture should be considered in the differential diagnosis of unexplained acute left upper quadrant abdominal pain.
脾脏外伤性破裂在医学文献中已有充分描述，约30%的钝性腹部损伤手术患者会出现这种情况。非外伤性脾破裂的描述则少得多。本文描述了一例肿大脾脏的非外伤性破裂病例。该病例中脾脏自发性破裂的病因无法确定。患者曾两次在急诊科就诊并出院；在随后入院三天后进行急诊剖腹手术时才确诊。该病例应提醒急诊医生，在不明原因的急性左上腹疼痛的鉴别诊断中应考虑非外伤性脾破裂。
